Raymond J. Melrose

Necrotizing sialometaplasia. A disease simulating malignancy

Results of a clinicopathologic study of seven cases of a previously unreported disease of minor salivary gland are presented. Necrotizing sialometaplasia is a disease of adults with four of seven patients being in the sixth decade of life. In every case, this benign inflammatory process involved only the tissues covering the hard palate, and, in six instances, it was characterized by ulceration. Lobular necrosis and marked squamous metaplasia of salivary gland are consistent features. Microscopically, necrotizing sialometaplasia shows marked similarity to mucoepidermoid carcinoma, and criteria are presented to aid in distinguishing these two conditions. There have been no recurrences following local surgical excision. Etiologic factors remain obscure.

Florid osseous dysplasia. A clinical-pathologic study of thirty-four cases.

Thirty-four patients with florid osseous dysplasia were studied. The majority were asymptomatic Negro women: Seventeen biopsy-proven simple bone cysts were found in affected quadrants of fourteen patients. Radiographs displayed a spectrum of sclerotic and ground-glass opacities limited to alveolar processes but not to root apices. Biopsy material was studied in all cases, and biochemical analyses of serum and cyst fluid were performed on some patients. Test results and skeletal radiographs indicate that the disease is limited to the jaws. Patients have remained asymptomatic with little alteration of radiographic patterns. Three cysts failed to heal following treatment, others filled with radiographically abnormal tissue. Chronic osteomyelitis may infrequently complicate the disease. These cases appear to represent the most exuberant manifestation of this reactive fibro-osseous jaw disease.

Intraosseous benign neural sheath neoplasms of the jaws: Report of seven new cases and review of the literature

Benign neural sheath neoplasms occurring centrally within the jaws are most uncommon. Our search of the English-language literature revealed twenty-eight previously reported cases. Seven additional cases--five neurofibromas and two neurilemmomas--are newly described here. Most cases have not been associated with multiple neurofibromatosis. These tumors occur predominantly in females, in patients under 45 years of age, and in the posterior mandible. The tumors generally present as asymptomatic radiolucencies, but some are associated with pain and/or swelling. Neurofibromas tend to recur more often than neurilemmomas when treated by conservative local excision.

Central odontogenic fibroma : clinicopathologic features of 19 cases and review of the literature

The odontogenic fibroma is a benign neoplasm infrequently reported in the literature (20 cases). Nineteen additional examples are reported. This lesion occurs most frequently in the maxilla anterior to the molars and displays a striking female predilection. On occasion, it may be associated with an unerupted mandibular third molar. Histomorphologically, it is not encapsulated. A spectrum of fibrous connective tissue stroma is present: from myxoid to densely hyalinized and from relatively acellular to cellular. Calcification may or may not be present. It is distinguished by the presence of sparse cords and islands of inactive odontogenic epithelium. Enucleation or surgical curettage is appropriate therapy and recurrence is low. As there appears to be no correlation of histologic pattern with clinical behavior, it seems unnecessary to try to separate the tumor into two variants.

Lobular (polymorphous low-grade) carcinoma of minor salivary glands: A clinicopathologic study of twenty cases

Twenty cases of a recently described adenocarcinoma of minor salivary gland--lobular carcinoma--are reviewed. This distinctive lesion occurs most frequently on the palate of patients in their sixth and seventh decades and displays no apparent sex or race predilection. Histomorphologically, the tumor is characterized by cytologic uniformity, bland nuclear chromatin, and low mitotic rate. Its lobular configuration and marked infiltrative tendency, often by single-filed tumor cells, are reminiscent of lobular carcinoma of the breast. Follow-up data indicate a favorable prognosis and are in accord with findings of previous investigators. The possible relationship of this lesion to adenoid cystic carcinoma is discussed.

Adenoameloblastoma. A clinical pathologic study of ten new cases

Ten new cases of adenoameloblastoma were studied. Three were entirely extraosseous. Females predominated; age ranged from 9 to 16 years and the lesions were most often associated with an unerupted permanent maxillary anterior tooth. Painless swelling or missing teeth were the most frequent presenting symptoms for intraosseous lesions while peripheral lesions presented as painless gingival swellings. A well‐demarcated radiolucency containing faint radiopacities characteristically surrounded the crown and portions of the root. Simple enucleation was curative. Encapsulation, duct‐like structures containing eosinophilic hyaline material, spindled epithelium, cribriform pattern, microcyst formation, intraluminal calcification and dystrophic calcification of degenerated connective tissue were common histologic features. Results of special stains suggested possible connective tissue origin for the hyaline material. There were no clinical or microscopic similarities noted between the adenoameloblastoma and the simple ameloblastoma. “Odontogenic Adenomatoid Tumor” is suggested as a more acceptable designation.

Extranodal oral lymphoma. Part II. Relationships between clinical features and the Lukes-Collins classification of 34 cases

Thirty-four cases of extranodal oral lymphoma were classified according to the Lukes-Collins system on the basis of morphology and immunoperoxidase staining, and these findings were correlated with the clinical features of each case. Vestibule and gingiva, mandible, palatal soft tissue, and maxilla were, respectively, the most common locations for all the tumors, and the most frequently stated signs and symptoms were swelling, pain, paresthesia, anesthesia, ulceration, and discoloration. Eighty percent of the lymphomas were composed of transformed follicular center cells or postfollicular cells. Patients with lymphomas composed of nontransformed follicular center cells had a greater mean age than those with tumors of transformed follicular center cells or postfollicular cells, and a trend of decreasing age with increasing B cell transformation of the tumor type was seen. Within each Lukes-Collins category, the percentage of tumors that presented with bone involvement increased as the tumor category advanced in B cell transformation. Follow-up information indicated that the prognosis was poorest with postfollicular lymphomas, intermediate with transformed follicular center cell lymphomas, and best with nontransformed follicular center cell lymphomas.

Monomorphic adenomas of the major and minor salivary glands

Monomorphic adenomas are benign salivary gland tumors that have a predilection for development in the upper lip and parotid gland. Typically, patients are older persons (mean age, 61 years), but a broad age range (32 to 87 years) has been reported in the literature. Adequate treatment consists of superficial or total parotidectomy (depending on extent and location of the tumor) for parotid lesions and excision with a limited border of normal tissue for minor gland tumors. Uniform cellularity, lack of myxoid or chondroid features, and a tendency for multicentric origin are features which separate these tumors from pleomorphic adenomas. Monomorphic adenomas have been mistakenly diagnosed and treated as adenoid cystic carcinomas. Close attention to cytologic detail, histomorphology, and growth pattern at the periphery are important in separating these tumors.

Human ameloblastoma tumors express the amelogenin gene

Instructive signals are responsible for the regulation of the expression of gene products characteristic of many cell lineages during normal development and potentially during neoplasia. The odontogenic origin of ameloblastomas is based largely on the similarity in histologic appearance between the tumor and the developing tooth organ. A pathognomonic pattern for odontogenic tissue-specific gene expression in ameloblastomas has not been previously shown. In these studies, the gene expression parameters for human ameloblastomas have been characterized with the techniques of messenger RNA phenotyping in combination with Northern and in situ hybridization analysis of messenger RNA. The results of these studies confirm that amelogenin, a gene transcribed solely by differentiated ameloblasts, was expressed by epithelial cells from human ameloblastomas. This observation suggests that the instructive signals required for ameloblast differentiation are shared during normal development and tumorigenesis of odontogenic epithelium.

Extranodal oral lymphoma. Part I. A morphologic and immunoperoxidase study of 34 cases

Thirty-four cases of oral lymphoma were classified by the Lukes-Collins system on the basis of morphology and immunoperoxidase staining. Ninety-seven percent of these were morphologically identified as B-cell neoplasms: 6% SCFCC, 9% LCFCC, 26% SNCFCC, 24% LNCFCC, 12% IBS, and 18% malignant plasma cell proliferations. Monoclonal immunoperoxidase staining for cytoplasmic immunoglobulin was positive in 41% of the cases overall, but 100% of the cases of immunoblastic sarcoma and malignant plasma cell lesions stained positively.